Organization
PES-EBS.INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER STOCKMAN (PRESIDENT)
(530) 888-1010
Entity
Organization
Contact information
Practice address
2060 CHICAGO AVE STE A9, RIVERSIDE, CA 92507-2316
(530) 888-1010
Mailing address
11837 KEMPER RD STE 2, AUBURN, CA 95603-9067
(530) 888-1010
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8048
—
CA
Enumeration date
12/24/2018
Last updated
04/03/2019
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